Impact of Cognitive Impairment on Long-Term Outcomes After Transcatheter Aortic Valve Implantation.

Circulation reports Pub Date : 2024-08-06 eCollection Date: 2024-09-10 DOI:10.1253/circrep.CR-24-0078
Norihisa Miyawaki, Kenichi Ishizu, Shinichi Shirai, Katsunori Miyahara, Ko Yamamoto, Tomohiro Suenaga, Akira Otani, Kenji Nakano, Tadatomo Fukushima, Euihong Ko, Yasuo Tsuru, Miho Nakamura, Toru Morofuji, Takashi Morinaga, Masaomi Hayashi, Akihiro Isotani, Nobuhisa Ohno, Shinichi Kakumoto, Kenji Ando
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Abstract

Background: Cognitive impairment assessed using the Mini-Mental Status Examination (MMSE) is associated with short-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of cognitive impairment in patients with severe aortic stenosis post-TAVI.

Methods and results: We enrolled 1,057 consecutive patients who underwent TAVI at the Kokura Memorial Hospital and prospectively assessed them using the MMSE. Results showed that 319 (30%) patients had cognitive impairment. Compared with normal cognition, cognitive impairment was associated with an increased risk for 5-year all-cause mortality (55% vs. 39%; P<0.001), cardiovascular mortality (23% vs. 14%; P=0.007), and non-cardiovascular mortality (42% vs. 29%; P<0.001). Multivariable analysis showed that cognitive impairment was independently associated with all-cause mortality (adjusted hazard ratio [aHR] 1.37; 95% confidence interval [CI] 1.10-1.70; P=0.005), and this result was consistent regardless of stratification based on age, sex, body mass index, left ventricular ejection fraction and clinical frailty scale without significant interaction. Patients with MMSE scores <16 had a significantly higher mortality rate compared with patients with MMSE scores >25, 21-25, and 16-20, respectively.

Conclusions: Cognitive impairment assessed using MMSE scores is independently associated with an increased risk for 5-year all-cause mortality in patients undergoing TAVI.

认知障碍对经导管主动脉瓣植入术后长期疗效的影响
背景:使用迷你精神状态检查(MMSE)评估认知障碍与经导管主动脉瓣植入术(TAVI)后的短期死亡率有关。我们评估了认知障碍对经导管主动脉瓣植入术后重度主动脉瓣狭窄患者的长期预后影响:我们在小仓纪念医院连续招募了 1,057 名接受 TAVI 的患者,并使用 MMSE 对他们进行了前瞻性评估。结果显示,319 名患者(30%)存在认知障碍。与认知正常的患者相比,认知障碍与5年全因死亡率风险增加有关(分别为55%对39%;P25、21-25和16-20):使用 MMSE 评分评估的认知功能障碍与 TAVI 患者 5 年全因死亡率风险的增加密切相关。
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